幕上大面积脑梗死急性期临床CT分型与预后的关系

目的研究幕上大面积脑梗死急性期临床CT分型方法,并探讨分型和预后的关系。方法连续收集发病24 h内就诊的幕上大面积脑梗死患者130例。均行急诊头部CT扫描,排除脑出血,并行牛津郡社区卒中项目分型、美国国立卫生研究院卒中量表评分。发病后24~72 h复查CT,将病灶最大径>5 cm并同时累及两个或两个脑叶以上者视为大面积脑梗死。先根据病灶受累血供范围分为三组,(1)>大脑中动脉(middle cerebral artery,MCA)分布区;(2)MCA分布区;(3)大脑前或大脑后动脉分布区。再根据CT所提示病灶近皮质处侧支循环好坏、是否完全或部分累及皮质区、放射冠区、深穿支区,将前两组分出亚型。结果脑梗死面积按分型方法:第1组有20例,第2组有102例,第3组仅有8例。第2组可分为MCA、完全MCA加侧支好、MCA减皮质、MCA减深穿支、MCA减深穿支加侧支好、MCA皮质6个亚型。第1组和第2组的完全MCA亚型预后最差;MCA皮质亚型较完全MCA加侧支好、MCA减深穿支、MCA减皮质3个亚型有好的预后趋势。结论本研究的临床CT分型方法简便易行,可指导判断预后。

The clinical classification and prognosis of supratentorial large cerebral infarction based on the cranial computed tomography imaging in acute stage

Objective To investigate the clinical classification of the supertentorial large cerebral infarction based on the computed tomography imaging in acute stage, and to analyze the correlation between the classification and prognosis of infarction. Methods Patients with the first attacked ischemic stroke who presented within 24 hours of onset were assessed by the Oxfordshire Community Stroke Project classification and the National Institutes of Health Stroke Scale. Cranial CT study was carried out immediately to rule out intracranial hemorrhage. A follow-up CT scan was performed within 48-72 hours after stroke. A total of 130 consecutive large cerebral infarction were selected for this study. Infarction were divided into three groups based on the anatomic location of the lesions: (1) involved more than middle cerebral artery (MCA) distribution; (2) involved only MCA distribution; (3) involved anterior cerebral artery or posterior cerebral artery distribution. The first and the second group were further divided into subtypes according to two primary radiologic evidence: (1) if the cortex, the subcortical white matter and the deep MCA territories were totally or partially involved; (2) if there is a good cortical collateral circulation adjacent to the infarction. Results The first group was 20 cases, the second group was 102 cases, and the third group was 8 cases. The second group could be divided into 6 subtypes, including total MCA distribution, MCA distribution with good cortical collateral circulation, part of the MCA distribution sparing the basal ganglia , part of the MCA distribution sparing cortical, MCA distribution with good cortical collateral circulation and sparing the basal ganglia. The prognosis of the first group and the subtype of total MCA distribution were the worst , the subtype of MCA distribution involving only superficial cortex had a better prognostic tendency than the subtype of MCA distribution with good cortical collateral circulation, part of MCA distribution sparing the basal ganglia and part of the MCA distribution sparing the basal ganglia. Conclusion This classification protocol may be an ideal one, it makesmuch contribution to exactly evaluate the prognosis.